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CiHM/ICMH 

Microfiche 

Series. 


CiHM/ICIVIH 
Collection  de 
microfiches. 


Canadian  Institute  for  Historical  l\Aicroreproductions  /  Instltut  Canadian  de  microreproductions  historiques 


Technical  and  Bibliographic  Notes/Notes  techniques  at  bibliographiques 


The  Institute  has  attempted  to  obtain  the  best 
original  copy  available  for  filming.  Features  of  this 
copy  which  may  be  bibliographlcally  unique, 
which  may  alter  any  of  the  images  in  the 
reproduction,  or  which  may  significantly  change 
the  usual  method  of  filming,  are  checked  below. 


D 


D 
D 


D 


Coloured  covers/ 
Couverture  de  couleur 


I     I    Covers  damaged/ 


Couverture  endommag6e 

Covers  restored  and/or  laminated/ 
Couverture  restaur6e  et/ou  peliiculie 

Cover  title  missing/ 

Le  titre  de  couverture  manque 

Coloured  maps/ 

Cartes  giographiques  en  couleur 

Coloured  ink  (i.e.  other  than  blue  or  black)/ 
Encre  de  couleur  (i.e.  autre  que  bieue  ou  noire) 


I      I    Coloured  plates  and/or  illustrations/ 


D 


Planches  et/ou  illustrations  en  couleur 


Bound  with  other  material/ 
Reil4  avec  d'autres  documents 


Tight  binding  may  cause  shadows  or  distortion 
along  interior  margin/ 

La  re  liure  serr6e  peut  causer  de  I'ombre  ou  de  la 
distortion  ie  long  de  la  marge  int6rieure 

Blank  leaves  added  during  restoration  may 
appear  within  the  text.  Whenever  possible,  these 
have  been  omitted  from  filming/ 
li  se  peut  que  certaines  pages  blanches  ajouttes 
lors  d'une  restauration  apparaissent  dans  ie  texte, 
mais,  lorsque  ceia  itait  possible,  ces  pages  n'ont 
pas  6t6  fiim^es. 

Additional  comments;/ 
Commentaires  suppl6mentaires: 


The 
tot 


L'Instltut  a  microfilm^  le  meilleur  exemplaire 
qu'il  lui  a  6t6  possible  de  se  procurer.  Les  details 
de  cet  exemplaire  qui  ^ont  peut-Atre  uniques  du 
point  de  vue  bibliographique,  qui  peuvent  modifier 
une  image  reproduite,  ou  qui  peuvent  exiger  une 
modification  dans  la  methods  normale  de  filmage 
sont  indiqute  ci-dessous. 


□   Coloured  pages/ 
Pages  de  couleur 

□    Pages  damaged/ 
Pages  endommag6es 

I     I   Pages  restored  and/or  laminated/ 


n 


Pages  restauries  et/ou  peliiculies 

Pages  discoloured,  stained  or  foxet 
Pages  d6color6es,  tachetdes  ou  piqu6es 

Pages  detached/ 
Pages  d6tach6es 

Showthroughy 
Transparence 

Quality  of  prir 

Quaiiti  in6gaie  de  I'impression 

Includes  supplementary  materif 
Comprend  du  materiel  suppl^mentaire 


r~T1  Pages  discoloured,  stained  or  foxed/ 

I      I  Pages  detached/ 

r~y]  Showthrough/ 

I      I  Quality  of  print  varies/ 

I      I  Includes  supplementary  material/ 


The 
pos 
oft 
film 


Orif 
beg 
the 
sior 
oth( 
first 
sior 
oril 


I      I    Only  edition  available/ 


The 
shal 
TIN 
whi 

Maf 
diff( 
enti 
begi 
rigli 
reqi 
met 


Seuie  Edition  disponible 

Pages  wholly  or  partially  obscured  by  errata 
slips,  tissues,  etc.,  have  been  ref limed  to 
ensure  the  best  possible  image/ 
Les  pages  totalement  ou  partiellement 
obscurcies  par  un  feuillet  d'errata,  une  pelure, 
etc.,  ont  M  fiimies  A  nouveau  de  fapon  d 
obtenir  la  meiiieure  image  possible. 


This  item  is  filmed  at  the  reduction  ratio  checked  below/ 

Ce  document  est  filmi  au  taux  de  rMuction  indiquA  ci-dessous. 

10X  14X  18X  22X 


12X 


16X 


20X 


26X 


XX 


24X 


28X 


D 

32X 


lire 
ditails 
ues  du 
:  modifier 
ger  une 
I  ffiimage 


i6es 


The  copy  filmed  here  has  been  reproduced  thanits 
to  the  generosity  of: 

National  Library  of  Canada 


The  images  appearing  here  are  the  best  quality 
possible  considering  the  condition  and  legibility 
of  the  original  copy  and  in  Icoeping  with  the 
filming  contract  specifications. 


Original  copies  in  printed  paper  covers  are  filmed 
beginning  with  the  front  cover  and  ending  on 
the  last  page  with  a  printed  or  illustrated  impres- 
sion, or  the  bacit  cover  when  appropriate.  All 
other  original  copies  are  filmed  beginning  on  the 
first  page  with  a  printed  or  illustrated  impres- 
sion, and  ending  on  the  last  page  with  a  printed 
or  illustrated  impression. 


The  last  recorded  frame  on  each  microfiche 
shall  contain  tho  symbol  — »■  (meaning  "CON- 
TINUED"), or  the  symbol  ▼  (meaning  "END"), 
whichever  applies. 


L'exemplaire  filmA  fut  reproduit  grAce  d  la 
gAnArosit*  de: 

BibliothAque  nationale  du  Canada 


Les  images  suivantes  ont  4tA  reproduites  avec  le 
plus  grand  soin,  compte  tenu  de  la  condition  et 
de  la  nettet*  de  l'exemplaire  f  ilm«,  et  en 
conformity  avec  les  conditions  du  contrat  de 
filmage. 

Les  exemplaires  originaux  dont  la  couverture  en 
papier  est  ImprimAe  sont  filmte  en  commenpant 
par  le  premier  plat  et  en  terminant  soit  par  la 
dernlAre  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration,  soit  par  le  second 
plat,  selon  le  cas.  Tous  les  autres  exemplaires 
originaux  sont  filmte  en  commenpant  par  la 
premiere  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration  et  en  terminant  par 
la  derniAre  page  qui  comporte  une  telle 
empreinte. 

Un  des  symboles  suivants  apparaftra  sur  la 
dernlAre  image  de  cheque  microfiche,  selon  le 
cas:  le  symbols  -^  signifie  "A  SUIVRE",  le 
symbols  V  signifie  "FIN". 


re 


Maps,  plates,  charts,  etc.,  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  exposure  are  filmed 
beginning  in  the  upper  left  hand  corner,  left  to 
riglit  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  illustrate  the 
method: 


Les  cartes,  planches,  tableaux,  etc.,  peuvent  Atre 
filmte  k  des  taux  de  reduction  diffArents. 
Lorsque  le  document  est  trop  grand  pour  Atre 
reproduit  en  un  seul  clichA,  il  est  filmA  A  partir 
de  Tangle  supArieur  gauche,  de  gauche  k  droite, 
et  de  haut  en  bas,  en  prenant  le  nombre 
d'images  n6cessaire.  Les  diagrammes  suivants 
illustrent  la  mAthode. 


y  errata 
Id  to 

nt 

ne  pelure, 

i^on  A 


U 


1  2  3 


32X 


1 

2 

3 

4 

5 

6 

■.  ■  /■- 


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I*  Sri**-' 


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D  I  S  S  E  R  T  A  T I  O  n;^ 

,    ON     THS      ■  **    ! 

Puerperal  -Fever, 

DEL  I  VERB  l» 

At  a  Public  Examination  for  the  Degree  ii£ 
BACHELOR   IN   MEDICINE, 

,   BEFORE    THE   ReVERBUD  - 

Joseph  WiLLARD,^.7!Z).  Pre'fideiitf 
The  Medical  Professors, 

The  Gpv«RM0RS         ^ 

Of  t])l:l?sfTJ[5^SITr  ^t  CAMBRlbGE>J 

Iji   i^ERiCA^ 

ETER  DE^^  S^        LA  IrERRIERli    ! 
From  Canada. 

,Cor  dolft  tdthonttu  quoties  reminiTcor  amarM  ^|ii|. 
raoda  fubit  faemina  fjfepa^victs.  "  ' '  ^'* 

•  BOS    T    OH  J  ^ 

•  *       ■ 

'ii      Prmted  by  Samuil  HALt,V  at  ^N«*  I3,  C^r 

*         mDCtLXXXtt, 


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^'^^:l.ft,-.... 


THIS    DISSERTATION 

is  DEDICATED,  WITH  ALL  RESPECT, 

TO 

JOHN   WARHEN,  M.  B. 

Profcflifr  of  Anatomy  and  Surgery  ; 

BENJAMIN  WATERHOUSE,  M.  D. 

Frofeflbr  of  the  Theory  and  PraAice  of  Phyfic  ; 

AARON    DEXTER,   M.  D. 

Profeflbr  of  Chemiftry,  and  Materia  Mcdica  ; 

(Gentlemen  not  more  diftinguifhcd  by  their 

LITERARY  ACCOMPLISHMENTS^  and  thcir 

PROFESSIONAL  ABILITIES^  than  refpcAcd 
for  their  attention  to  student§,  and 
their  talents  for  instruction  j    *^' 

By  their  ; 

Humble  Servant}  '     ^| 

PETER  DE  SALES  tA  TERRIERE. 


'■'■      f. 


f     5     3 


»*<»»jt»«»jfairtiNw«»w, 


V 


IT  Is  not  without  diffidence  that  I  appear  before  this 
HONOURAtLK  and  RiTERBND  AssBMBLY,   in  Con- 
formity to  the  Ifiudable  cuftom  eftabliftied  in  the 
Univcrfity. 

To  prodiice  a  differtation  in  a  language  I  have  neter  pro* 
feffedly  ftudied,  before  I  entered  thefe  walU,  is  not  fo  eaff 
•  laflc  as  fome  perhaps  may  imagine  :  but  relying  on  that 
candor  Vrhich  diftinguiflies  a  polite  education^  I  am  em- 
boldened to  offer  you  this  fpecimen  of  my  ftudicsi  hoping 
that  every  deficiency  of  language  will  be  excuKj^d. 

I  (hall  fay  a  few  words  for  the  information  of  thofe  who 
may  wonder  to  fee  a  pet fon  of  my  age  engaging  in  the  ftu- 
^y  of  Phyfic.  The  occalion  of  it  is  this  ;— Canada,  like 
moft  provinces  at  a  great  diftance  from  the  mother  coun- 
try»  has  become  Very  deficient .'  .  medical  knowledge.  Not 
only  the  moft  approved  Engh.;.  authdrs  are  unknown  to 
inoft  of  us,  but  even  the  late  French  writers  on  phyfic 
^nd  furgery.  are  fcarcely  I'een  among  us. 

Ignorance  and  quackery  having,  from  thefe  and  fome 
Other  caufes,  fpread  among  us,  to  the  great  detriment  of 
the  lives  of  his  Britannic  Majefty's  fubje£^s,  it  excited  the 
attention  of  tlft  legiflature,  and  particularly  of  the  hu- 
mane Lord  Dorcheflert  who,  touched  with  a  tender  feeling 
for  the  fufferings  of  others,  iiTued  an  Ordonnance, obliging 

every 


C     6     3 

every  pradltioner  to  undergo  an  examination  before  a  com* 
mutee  of  phyficians  and  members  of  the  legiflative  councit*^ 

The  refult  of  this  plan  was,— A  certain  number  having 
been  examined,  were  approved,  and  permitted  to  go  OA 
in  pradlice  :  a  nurnber  were  rcjeAed  as  unqualified,  and  « 
prohibited  pradtliing  ;  and  fome  wece  paffcd  condition* 
ally,  that  is,  they  were  recommended  to  pafs  fome  tim£ 
at  any  univerfity,  where  medicine  was  taught  with  regu- 
larity, according  to  the  mod  improved  Britiih  fyftems. 

Finding  myfelf  included  among  the  lad,  I  took  from 
the  regider^s  office  what  concerned  myfelf  only,  and  fet  off 
for  the  Univerdty  of  Cambridge,  which  had  been  Ilrong* 
ly  recommended  to  me  as  a  medical  fchool,  where  1  could 
obtain  every  thing  the  ordonnance  required  of  me. 

Although  I  had  formed  an  high  idea  of  the  Univerfity 
of  Cambridge,  and  of  the  medical  Uflurcs  in  particular, 
yet  I  am  happy  in  declaring  that  they  far  exceed  my  mod 
fanguine  expectations,  and  I  fhall  account  thofe  circumdan- 
ces,  which  I  once  was  ready  to  conceive  as  grievances* 
among  the  mod  fortunate  events  of  my  life,'>inafmuch  as 
they  have  made  me  acquainted  with  a  fet  of  truly  learned 
men,  whofe  urbanity,  as  well  as  abilities,  I  (hall  nevdr  ceafc 
to  revere.  . 


«» 


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mmmmm 


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.      V 


DISSERTATION 

ON     THE  • 

Puerperal   Fever. 

»  - 


)• 


Vm 


TH  E   puerperal  fever  is  a  diforder  peculiar  to 
women  in  child-bed  ;  and  although  it  is  pro- 
bable it   hath  happened   in  all  ages  of  the 
world,  Its  canfe  is  (till  involved  in  much  ob- 
fcurity,  and  its  mode  of  treatment  left,  in  a  great  meafurc, 
undecided. 

The  numbej;9cut  off  by  this  difeafe,  in  Canada,  have  moved 
my  compafliott,  and  excited  me  to  enquire  into  its  nature, 
and  to  try  to  afcertain  the  proper'  method  of  cure  ;  but 
alas  !  I  find  even  the  moil  celebrated  Englifh  phyficians, 
vvho  have  written  on  the  fubjed,  differing  in  judgment 
with  each  other,  ani  the  fame  appearances  after  death  ex* 
plained  in  a  different,  and  fometimes  oppoijte  manner. 

Some  practitioners  doubt«  whether  it  be  a  primary  or 
a  fecondary  difcafe.  Some  confider  it  as  arifing  from  an  in- 
flammation of  the  uUrus  i  others  fuppofe  it  to  be  occafioned 


ill 


//?■ 


t    i    3    .- 

,\)j  an  obftru£iion  of  the  fecretion  of  the  milk,  wtiile  many 
other!  imagine  ic  arifei  from  a  fuppreflion  of  the  Mia 
merely. 

• 

-It  commonly  begins,  like  other  fevers, -with  rigour  on 
the  I  ft,  2d,  and  3d  day  after  delivery,  which  is  followed 
by  great  pain  and  forenefs  over  the  whole  hypogaftrie  ' 
region  ;  there  is  a  fenfe  of  heat  and  throbbing  about  the 
region  of  th^  uterus.  There  'is  much  ihirft,  pain  in  the 
head,  chiefly  in  the  pares  about  the  eye-brows,  a  flufhing 
in  the  face,  anxiety,  a  hot,  dry  ikin,  quick  and  weak  pulfe, 
though  fometimes  it  will  refift  the  finger  ftrongly,  accoo^- 
panied  with  other  figns  of  inflammation  ;  a  fhortnefs  in 
breathing,  high  coloured  urine,  and  a  fuppreiUon  of  the 
lochia. 

A  change  in  the  quality  of  the  lochia  takes  placCf 
together  with  a  tenefmus.  Sometimes  the  patient  vomits^ 
from  the  beginning,  a  matter  refembling  what  isdifcharg- 
ed  in  the  cholera  morbui* 

'    When  the  fever  has  continued  a  few  days,  the  fymptoms 
of  inflammation  ufually  fubfide,    and  the  difeafc  takes  a 
putrid  form  ;  a  bilious  or  putrid  diarrhoea  (upervenes,  the  * 
ftools  become  idvoluntary,  and  the  patient  dies. 

• 

Although  this  difofder  begins  fometimes  like  a  regular  fe- 
ver, and  at  others  fhows  fymptoms  of  genuine  infIa||imation ; 
yet  it  feems  to  differ  from  both,  and  exhibits  thofe  fymp- 
toms of  irritation,  with  fudden  depreflion  of  ftrecgth, 
quick  and  low  pulfe,  dizzinefs,  glazy  eyes,  and  that  fpecies 
of  delirium  which  denote  a  diminifhed  energy  of  the  brain ; 
the  fymptoms  are  fucb  as  commonly  ari/e  wlien  the  mucous 

•  membrane 


■l*MM|H 


. 


t»- 


C      9      ] 

membrane  of  the  throat,  mtedinefi,  bladder  or  uterus  are 
inflamed,  which  the  (Icilful  pradlitlorler  knows  to  be  ver/ 
different  from  the  fymptoms  that  arife  when  a  thick, 
mufcular  part  is  inflamed.  I  cannot  cxpicfs  my  meaning 
better  than  by  faying,  that  it  is  that  kind  of  inflammation 
in  which  blood-letting  is  contra-indicated,  and  in  which 
tonics  are  chiefly  to  be  relied  on.    . 

The  puerperal  fever  may  be  didinguifheJ  from  the  mili- 
ary, by  the  rigour  being  more  violent,  and  without  inter- 
ruption :  and  the  eruptions,  which  are  critical  in  the 
miliary  fev^r,  procure  no  mitigation  in  the  puerperal. 

-  Phyficians  hare  differe3  nearly  as  much  in  their  judge- 
ment lefpeftlng  the  method  of  cure,  as  in  the  nature  of 
the  difeafc.  Dr.  Den'man  fuppofcs  it  to  arife  from,  a  re- 
dundancy or  preternaroral  acrimony  of  the  bile,  the  fccre- 
tion  of  which  is  irregular  during  pregnancy.  Dr,  Man* 
ntng  is  of  the  fame  opinioa,  only  he  lays  much  (trefs  on 
unwholefome  air  and  bad  diet* 

Dr.  Hulme  dTIffcrs  from  both  thefc  refpedlable  phyiicians,^ 
fays  it  is  owing  to  an  inflammation  o£  the  omenttim  and 
inteftines,  and  maintains  his  argument  by  a  variety  of  dif- 

*  fedtions  ;  and  the  celebrated  Dr.  John  Hunter  is  fo  far  of 
this  opinion,  that  he  thinks  it  is  poHible  even  for  men  to 
have'a  diforderlike  it,  and  fays  that  he  has  known  ilmilar 
appearances  in  the  omentum  and  inteitines  of  men,  whofc 

'abdomens  have  been  diilended  by  dropfy. 

Dr,  Httlnte  readily  admits,  that  unislrholefome  air,  and 
bad  diet,  may  powerfully  operate  in  cauflng  the  difeafe. 
With    thrt   idea.  Dr.   Hulme   proceeds*  to  th«  cure   by 

B  cmolllenc 


wteiS*. 


C 


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] 


t 

I 

I 

:  I 
1 

(  I 


emollient' iiijeflions,  and,  If  the  abatement  of  pain  it 
not  foon  procured,  he  recommends  fal  catharticus  ama- 
rus,  oleum  ricini,  and,  in  the  intermediate  fpaces,  the  fa* 
line  draughti  of  Rivsrius,  The  complication  of  infiaiiima- 
lory  and  pu^crid  fymptoms  often  puzzles  the  praftitionery 
who  hefitates  in  doubt,  whether  he  (houjd  bleed  or  not  f 
nay  more,  whether  he  fliould  adopt  an  antiphlogiftic  courf« 
of  remedies,  or  give  the  bark. 

The  equivocal  appearances  of  the  vomiting  and  jp>org- 
ing,  whether  they  be  fymptomatical  or  critical,  is  another 
caufe  of  perplexity  in  the  phyfician  ;  for  what,  are  the  fa« 
lutary  efforts  of  nature,  and  wha^  the  ragings  of  a  defiruc- 
tive  difordur,  he  is  unable  to  determine  ;  and  this  difeafc  ii 
too'acute  to  allow  him  time  to  befitat'e  long. 

• 

As  many  womeir  yfrho  die  of  a  puerperal  feve-  are  af- 
^idled  with  a  dianhcea,  fome  have  fuppofed this  irmptom  . 
as  the  molt  alarming,  and  hlave  accordingly  bent  11  their 
attention  to  redrain  it ;  and  yet  the  experienced  pi  'fician 
knows  that  numbers  of  wom«n  have  recovered,  app?  ently,^ 
through  the  intervention  of  this  fymptom.  Some  nilan- 
ces  have  occurred  bf  hsfcmorrage  carrying  oflF  the  jii'eafe, 
and  this  has  been  thought  fufficient  to  juftify  veneiec.ion  i 
but  JDr.  Denman  thinks  we  are  warranted,  by  experience^ 
to  rejedl  the  practice  as  very  hazardous,  if  not  fatal  ;  and 
when  we  coniider  the  fituation  of  child-bed  women,  we 
Ihould  be  ape,  teafoning  a  prion,  to  conclude,  that  vene- 
fe^ion  was  ^nneceifary. 

"Whether  there  may  not  occur  cafes  in  the  coldcft  feafons, 
in  fuch  a  climate  as  Canada,  where  bleeding  would  be  be- 
neficial, future  experience  muft  determine. 

As 


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] 


>f 


As  Dr.  DenmaD  and  Dr.  Manning  fuppofc  that  acrid 
bile  chiefly,  foments  this  difeafe,  tKey  begin  with  emetics, 
and  then  have  recourfe  to  purgatives  ;  and  they  a0ert  they 
have  found  ihis  praAice  beneficial.  Dr,  Denman  ufes  the 
following  formula. 

R.  Tart,  emetic       gr.     -   -    I 

Ocnl.  cancror.      p.  fcrup.  i   Intime  mifceantur. 

The  dofe  is  6  gr.  of  this  powder;  and  if  the  firft  does  not 
produce  any  fenfible  operation,  he  repeats  it»  in*  an  en- 
creafed  quantity^  every  -two  hours.  He  gives  the  faltne  . 
^raughtSj  which  not  only«keep  up  the  evacuation  from  the 
inteftines,  but  lihewife  promote  the  falutary  difcharges  of 
urine  and  perfpiratJon. 

• 

When  a  diarrhoea  continues  to  fuchan  alarming  degree 
tl  to  threaten  a  fatal  termination*  he^^orders  injedtions  of 
chicken  water,  but  to  be  conduced  with  great  care,  on 
account  of  the  extreme  fenfibiiity  of  the  parts  contained  in 
ihe  pelvis.     He  then  adminifters  the  following  draught  : 

-R.  Pulv.  ipecac.  -  -  -     gr.     i 

Confe^.  democrat,   fcrup.  i. 

Aq.  alexit.  ilmp.  vcl,  aq.  cinam.  (imp.  unc.  i  m.  . 

•  •  • 

Dr..  Hulmet  fuppq/ing  that  the  proximate  cagfe  of  the 

puerperal  fever  is  an  inflammation  of  the  omentum  and  in* 

teftines,  fays,  that  th£  predifponent  caufe  is  the  preflurc  of 

the  gravid  uterus  againft  thefe  parts.     But  Mr.  White, 

another  eminent  Engh'fh  pra6litioner,  aiks,  if  this  were 

the  cafe,  whether  the  diforder  would  not  take  place  before 

delivery,  and  be  mitig9ted  immediately  after  that  period  ? 

Seeing  the  puerperal  fever  is  a  difeafe,  more  frequent 

and 


! 


'■ 


■'yMii». 


/ 


>f. 


C     I*     3 

and  more  fatal,  iif  large  cities  and  in  hofpitals,  than  in 
the  country,  and  in  private  practice,  fome  have  fuppofed« 
that  it  is  a  diforder  very  Hmitar  to  the  ctnanche  maligna^  or 
ulcerated  fore  throat  ?  Allowing  for  the  different  feat  of 
the  diforder,  they  afl<,  are  not  the  fymptonra  very  (Imilar  \ 
and  may  it  not  be  fuppofed  that  it  is  an  inflammation  of 
the  mucous  mepibrane  of  the  uterus  and  parts  adjacent  I 
and  do  not  the  equivocal  fymptoms  before  mentioned^  fQ 

fome  meafurc,  confirm  this  idea  ? 

»    '  ■>.••.' 

It  may  not  be  improper  to  obferve,  that  although  Dr^ 
Hulme  fuppofes  this  diforder  to^rife  from  inflammation* 
yet  he  fays  that  bleeding  is  to  be  ufed  wi.th  great  caution. 

From  the  beginning  of  the  y.ear  1768  to  1770,  the 
puerperal  fever  prevailed  much  in  and  about  London.  Dr. 
Leak  publifhed  tH^  obferyations  he  made  in  that  interval^ 
It  feemed  to  be  occafioned,  he  faid,  by  catching  cold>  or 
by  errors  in  diet,  but  oftener  by  anxiety  of  mind.  He 
fays  the  deprefpon  of  ftrength  was  foXudden  and  fo  great, 
that  few  of  the  patients  could  turn  in  bed  without  aflift- 
alice,  even  fo  early  as  the  fir  ft  or  fecond  day  of  the  attack. 
The  lochia,  he  obferves,  were  not,  from  firft  to  lad,  ob- 
ftrudled,  nor  deficient  in  quantity,  neither  did  the  quality 
of  the  difcharge  leem  to  be  altered  foom  its  natural  ftate  ; 
and  what  is  remarkable,  a  confiderable  preffure  above  the 
pubes  did  not  occafion  pain,  while  the  fame. degree  of  pref- 
fure betwfen  the  flomach  and  umbilical  region  produced 
a  pain  almoft  intolerable  ;  and  in  them  that  died,  he  fays 
the  omentum  was  found  fuppurated  ;  he  therefore  con- 
V:lude8,  with  Dr.  Hulme,  that  an  inflammation  of  that  part 
and  df  the  intellines,  is  the  proximate  caufc  of  the  djfor- 

<3cr 


^ 


K  \ 


J 


V. 


^ 


\ 


4er  we  are  now  treating  of.  In  confequence  of  this  idea^ 
he  advifes  venefed^ion,  and  recommends  it  from  his  own 
experience.  But  from  the  uniformity  of  the  fymptoms, 
in  the.  many  cafes  he  relates,  it  has  been  fuppofed  that  it 
was  a  difeafe/M<  generis,  then  epidemic. 

Dr.  Kirkland,  who  has  written  on  this  dif^afe,  recom- 
mends the  peruyian  bark,  and,  if  the  diarrhoea  fhould  be* 
come  very  alarming,  he  does  not  hedtate  taadd  fmalfdofes 
of  laudanum  to  the  bark.  He  warmly  recommends,  after 
Mr.  White,  the  columbo  root,  as  an  admirable  remedy  to 
remove  the  irritability  of  ^he  inteftinal  canal. 

Thus  much  have  I  been  able  to  gather  from  authors, 
apd  from  the  led^ures  given  in  this  univerfity,  refpe£|ting. 
the  nature  and  cure  of  this  de(lru£live  difeafe  ;  and  have 
now  to  add  a  few  obfervations  I  have  madb  in  my  own 
pra£^ice  in  Canada,  * 

Is  it  not  reafonable  to  fuppjofe,  that,  in  different  cli* 
mates,  the  puerperal  fever  wears  a  different  afpcft  ?  In  our 
cold  climate,  there  moft  commonly  prevails  th?*  ftatd  of 
the  arterial  fyftem,  which  is  known  b]f  the  name  oi  dla- 
thejis  phlogijika  ;  and  I  have  generally  found,  that  puer- 
peral patieqtsbear  bleeding  better  than  we  are  led  to  fup- 
pofe,  from  reading  thefe  £ngH(h  authors. 

Dr.  Leak's  defcription  of  the  difeafe  comes  the  neareft 
to  what  I  have  obferved  in  Canada  of  any  of  the  Englifh 
authors.  ^  • 

Dr*  Tlfoi*s  hiftory  of  the  difeafe  agrees  with  moft  of 
the  cafes  I  have  met  witJi,  and  his  mode  of  treatment  fecmi 

.        '  .  •*      .  well 

* 


? 


i 


-•<(«ii.j 


A 


I      «4     3 

vtU  adapted  to  our  climate.  I  have  found  very  beneficial 
effefls  from  emetics  and  ecoprotics,  and  i'ometimes  cathar* 
tic*  ;  and  io  many  inftanees  I  have  taken  away  2  oz.  of 
blood  with  evident  advantage  ;  but  in  moft  cafes*  I  am 
rather  deterred  from  ufing  venefedion  at  all.  > 

The  beft  way  of  preventing  this  difeafe  is  to  obviate  coft- 
Ivenefs  in  the  lad  months  of  pregnancy,  to  keep  the  wo* 
,  man^  after  deliver  y^  perfeAly  eafy  in  mind,  as  well  as  ia 
body. 

.  -Her  food  (hould  be  light*  and  in  fmall  quantities  ;  her 
chamber  (hould  be  properly  aired,  and  every  attention 
fhonid  be  paid  to  cleanlinefs.  ^ 

-  However  ignorant  we  may  be  of  the  nature  of  the  puer- 
peral fever,  o|  this  we  are  certain,  that  the  female  fyftem 
Is  in  flic]}  a  date,  on  delivery,  that  errors  in  either' of  th'efe 
refpefls  are  apt  to  produce  the  difeafe  ;  too  much  heat 
will.caufe  it  full  as  often  as  too  much  cold. 

That  particular  JIate  or  predifpofttion  of  their  bodies,  muil 
be  inquired  into,  before  we  can  throughly  underftand  this 
diforder* 

And  indeed,  from  a  view  of  the  wkole  matter,  I  am  in* 
duced  to  form  the  following  opinion  :  That  upon  thf 
nature  of  this  predifpoHtion,  the  difeafe  depends  ;  or,  in 
other  words,  that  the  diforder,  ufually  known  by  the  name 
pf  the  puerperal  fever,  or  that  fever  to  which  lying-in  wo- 
men are  more  peculiarly  incident,  alTumes  its  form  princi- 
pally from  circumftances  pre-exifting  in  the  fyft^m^  The 
circuroftance  of  parturition,  I  would  coirfider  only  as  an 

excUinv  caufe,  •  ' . 

Io 


•' 


•i 


•^ 


'^8^; 


M 


.    C    is    3  •     . 

In  this  view  of  the  matter,  let  us  examine  in  what  form 
It  may  be  cxpe£fced  to  make  it*»  jippcaranc^. 

The  ftate  of  pregnancy  may  be  confidered  as  having  ccjr- 
tain  efFc6^s  on  the  vifcera  of  the  abdomen  in  particular, 
and  on  the  whole  fyftem  in  general.  The  preiTure  of  the 
gravid  uterus  is  the  principal  agent  in  producing  them. 

The  evident  confcquences  of  this  prcffure  are,  i.  retention 
of  fsscal  matter  in  the  inteftines,  and  perhaps  in  the  bladder; 
2.  diminifhed  excretion  of  the  bile,  or  difficult  entrance 
into  the  duodenum  ;  3.  an  obftru6lion  to  the  free  courfe  of 
.the  chyle ;  and  4.  impeded  circulation  in  the  abdominal  vif- 
Cera.  The  laft  of  ihcfe  may  perhaps  be  confidered  as  the 
only  one  in  which  the  vifcera  in  particular  are  immediately 
intercftcd'.  • . 

The  circumftances  affediing  the  fyftem  in  general,  are, 
•— Dideniion  of  the  fibres  of  the  uterus,  which,  from  an  ex- 
tenfive  fympathy  of  parts  with  this  organ,  rouft  neceifarily 
increafe  the  irritability  of  the  nervous  fyftem*: — From  an 
accumulation  of  putrid  matter  in  the  in'teftines,  an  abforp- 
tion  of  putrefcent  juices  « — The  collc^ion  of  bile  in  the 
receptacles  of  the  liver,  which,  by  (lagnating,  will' be  expo- 
fed  to  the  abforption  of  it^s  thinner  and  moft  diluting  parts, 
and  which  will  be  the  means  of  inducing  condipation  :--* 
Debility  through  the  want  of  a  nutritious,  cooling  fluid 
in  the  blood.  * 

A  combination  ofthefe  caufes'with  certain  peculiaritiei 
of  the  habit  may  heighthen  the  predifpofition. 

Th{  caufes  dependent  on  parturition  4tfelf  are, 

1.   Irritation 


'•TW*:, 


-   t.     Ifritation  upon  the  uterus. 

2.  Accelerated  circulation,  and  increafed  heat. 

3.  Sanguineous  evacuation. 

4.  Sufpenfion  of  the  requiCTte  difcharges. 

The  firft  of  thefe  may  very  readily  be  conceived  as  excit<* 
ing  difeafe,  by  means  of  the Tympathy  of  parts  with  the 
uterus;  and' it  will  confpire  with  the  already  increafed  ir- 
ritability. 

The  fecond  by  giving  a&ivity.to  the  retained  ftagnant 
fluidsi  as  the  bile  or  thinner  parts  of  the  fasces. 

The  third,  by  increafing  the  abfocption  of  tbofc  fluids, 
the  vcflcls  of  the  receptacles  being  rendered  more  bibu> 
lous  by  the  depletion.     And 

The  laft,  by  augmenting  the  quantity  of  colluvies,  and 
by  an.  applicatiou  of  putrid  matter  to  the  orifices  of  the 
uterine  vefl*els,  in  addition  to  that  contained  in  other  parts. 

Thkt  thefe  may  operate  differently  Tn  different  cafes  of 
predifpofition, feems  agreeable  to  the  diflates  of  reafon  and 
common  fenfe.  The  degrees  of  violence  in  the  attack  arc 
allowed  tS  depend  much  on  conftitution  and  on  predifpQ- 
fing  caufes  ;  and  why  may  not  the  nature  of  the  fymptoms 
be  dependant  on  them  alfo  ?  If  it  is  granted  that  they  may, 
ire  we  not  then  judified  in  concluding,  that  the  forms  of 
this  difeafe  may  be  various  in  different  cafes,  according  to 
the  predifpofition  of  the  habit  ?  and  may  not  the  jarring 
opinions,  and  diffentient  theories  which  the  ingenious  of  our 
profeffion  have  advanced,  be  readily  reconciled  by  thefe 
confiderations  ? 

•  Of 


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Of  the  two  leading  theories  that  have  been  advocated  by 
phyficians,  theone  makes  it  an  inflammatory,  the  other  t 
putrid  affection.  Trobably,  in  moft  cafes,  it  is  primarily 
inflammatory,  atod  finally  putrid  ;  but  may  it  not  cafily 
be  conceived,  that  a  puerperal-fever  which,  in  a  plethoric 
habit,  where  the  veflcls  being  turgid  are  lefs  ^ifpofcd  to 
abforption,  would  in  it's  origin  be  highly  inflammatory* 
might  in  a  thinner  habit,  where  the  irritability  is  great* 
aiTume  from  the  very  beginning,  a  putrid  type  \ 

I  have  been  informed  of  an  inftance,  in  this  Common-- 

wealth,  of  two  ingenious  pradiltioners  of  eminence  widely 

differing  in  fentiment  on  this  difeafe,  tenacioufly  fuport- 

ing  their  opinions  upon  fa£i  and  experience,  and  yet  fup- 

porting  them  in  dire£l  oppofition  to  each  other.     Might 

not  both  of  them  be  in  the  right,   and   even  the'  method 

of  cure  adopted  by  each  of  them  be  perfectly  juftifiable* 

though  the  one  recommended  an  antifeptic,  and  the  other 

an  antiphlogiftic  courfe  \   Tbey  both  pra&ifed  according 

to  the  obvious  fymptoms  of  the  malady  ;  the  one,  under 

appearances  a£tually  putrid,  prefcribed  antifeptics  ;    the 

other,    under   thofe  that  were  inflammatory^  prefcribed 

antiphlogiflics. 
« 

The  many  caufes  of  abforption  indeed  (hould  render  ui 
cautious  of  phlebotomy ;  but  I  conceive,  it  may  fometimei 
b^  indicated.  •    # 

It  may,  perhaps,  be  objefled  to  what  I  have  advanced, 
that  if  my  theory  is  right,  there  is  nothing  fpecific  in  thf 
puerperal  fever.— 

To  this  I  anfwcr— That  from  the  irritable  date  of  the 

C  uterus 


I 


\ 


t    »•     3 


ittffn»lii-pMtieuliir ;  frooi  iu  mcmkj  to  the  fi»tirc«t  of  ab- 
Iwrptton  ;  and  etlier  peoaHari ties  in  tt't  fitoattoo  unmedi- 
•Itlf  after  partm-ftiant  I  coticetfc  foeh  a  variety  io  the 
;^ani6ter  of  the  difitafe  to  be  eAi^ltihed,  as  may  fo  £ir 
render  it  a  difeafe  fin  generis  $  as  to  require  a  treatment 
very  di#erent  from  that  of  eicher  the  fynochat  typhae  or 
Jfuochus \  *and»  if  I  dared,  I  would  ventiive  to  give  it  » 
same  that  (honld  dcfigwate  it  as  a  puerperal  variety  of  the 
gentufynocbus. 

Dr.  Hulnie^s  diifl€6ttonB  have  proned  that  in  many  cafes  of 
triiil  is  called  the  pnerperal  fever,  an  inflamoiation  of  thi 
otttntnni  and  tntedines  was  the  proximate  cdufe.  This 
might  have  been  combined  with  a  diatbeiis  phlogiftica  ; 
ind  from  fome  of  the  remote  cat^s  above  mentioned,  they 
loomed  this  form.  It  is  to  be  prefiwied,  howrever,  that 
JDr.  Kulme  did  not  mean  to  confider  it  as  a  £mple  ente- 
ritis 5  but  -sfe  adiCeafe,  the  charader  of  which  depended  on 
the  conncxion-of  the  parts  which  were  the  feat  of  it,  with 
the  sterns  ;  thus  con*ftituting  a  diftinft  fpocics  in  a  manner 
fimilar  to  that  which  I  have  adopted  above. 

-.1.        ■'■;..■;-.■■■  '.  *       ■ 

As  to  any  inflammation  of  the  uterus  which  may  take 
placeinconfequenceof  parturition,  I  have  ncgUacd  to  fpeak 
of  h  as  conncaed  with  this  diCorder,  for  this  n  another  dlf- 
eafe,  and  it  is  that  which  baa  been  cpnfidcred  by  3>.  CuU 
)in  under  the  name  of  a  hyftcritis. 

«#    t^««dl  pay  due  attention  to  ^s  fobje^,  as  cafts  ^eur, 
>iiD^bope,-fome  t«ne  or*other,  to  lay  before  yoo  fome  far- 
ther obfervations,  in  addition  to  this  impcrfea  0Betcb. 


';t\ 


'i***-: 


Zfk9,ATUVi,%jhtMpaie,    For  f«pa  read  f«pe. 


''^'-•^-T 


■  •■■• 


fc.-j* 


